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Review |

Orbital Complications of Acute Sinusitis in Infants A Systematic Review and Report of a Case

Saurabh Sharma, MD1; Gary D. Josephson, MD, MBA2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
2Pediatric Otolaryngology–Head and Neck Surgery, Nemours Children’s Clinic, Jacksonville, Florida
JAMA Otolaryngol Head Neck Surg. 2014;140(11):1070-1073. doi:10.1001/jamaoto.2014.2326.
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Importance  Orbital infections from acute sinusitis are rare in neonates and infants and can lead to devastating complications. To our knowledge, no prior dedicated review exists for evaluation, treatment, and outcomes of orbital complications in this age group.

Objective  To perform a systematic review over the past 50 years on the diagnosis and treatment of orbital complications secondary to acute sinusitis in neonates and infants and report a case.

Evidence and Acquisition  A systematic review of the literature was performed searching PubMed to collect all the pertinent case reports and series in the English language with subperiosteal orbital abscess (SPOA) or orbital abscess in neonates or infants (date range, 1959-2012).

Results  Eleven cases of SPOA in infants were identified, including our current case. Ages ranged from 10 to 74 days. There were 6 female and 5 male infants. The right eye was affected in 5 cases, the left in 5, and both in 1. There was 1 mortality in this series for which surgical drainage was not performed. Staphylococcus aureus was the most common organism isolated in 9 of 11 cases. Seven of the cases had open surgical drainage, 2 had endoscopic procedures (including our case), and 1 had spontaneous rupture of the abscess.

Conclusions and Relevance  An orbital complication due to acute sinusitis is rare in infants and neonates. Drainage in this patient population appears to be paramount, since the only infant in this series who did not receive drainage had died. Modern telescopes and equipment have allowed endoscopic drainage to be a safe and effective surgical treatment in this age group.

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Figure.
Preoperative CT and Intraoperative Images

A, Axial view of the computed tomographic (CT) scan of the sinus with contrast delineating the subperiosteal abscess in the left orbit. B, Intraoperative image showing total ethmoidectomy performed on the left with purulent drainage noted after removal of the medial orbital wall.

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